Key

Text field doesn't enforce all the content in the section in human readable-- need to consider how different data types are viewable

Need to address new auth profile-- use HREX

Need to apply consistency on title fields

Identifiers-- SSN? which IDs

How long to store coverage info, how far look backs

Reconciliation from transfers

Should coverage info carry over from a prior reconciliation

Need to check that "active treatment" is actually reflected in FHIR 'Plan" and status "active"

Goals-- would that ever be coded field?

CertificationType-- an extension in priorauth-- what value set or responses should be constrained if any? what would this field mean in PCDE context?

Ideally would address what kinds of documents would be attached and what type in IG

Need to post a separate communication to the composition bundle-- then a service unpacks it and applies it to the record

Can we deposit a communication with the coverage transition bundle to automate the process/bundle and write back to the server attached to the patient

Will we use business treatment and operations via HIPAA?

Need to define a value set/code to request a coverage transition request in communication request.

Use LOINC code for the communication request document-- need to request one in a year-- until then use a placeholder custom code

Need also to select a communication category

Inside the Simplifhir US Core profiles there are some out of date value sets/profiles and these are throwing errors in testing

How will the payer organization be identified? Sender and the recipient?-- could use the FHIR endpoint-- would not specify the individual plan likely

Use the CDEX communication request profile for the IG?

FHIR validation

"A resource should have narrative for robust management"

What if the patient has no active treatments? What is sent? Reason code? Need to return a result code and a string "No active treatment"-- need to create new profile for no active treatment?:

status: not done,

status reason: Communication not done,

string: no active treatment,

subject: patient

Communication instead of document should be used when there is a patient found but no active treatment plan

Dont necessarily need a response to comm request but probably should – can point to a communication request in the payload but this makes workflow more difficult-- can send a separate comm request with the document

Communication instead of document should be used when there is a patient found but no active treatment planPatient as the subject, coverage as "about" – when member registers, need to ask the new member what the old coverage is